Clinic Observation Of Transurethral Thulium Laser Resection Of Prostate In Treatment Of Benign Prostate Hyperplasia: 52 Cases Report

Objective: The thulium fiber laser may have several advantages over current urology lasers, including smaller size, more efficient operation, improved spatial beam quality, more precise tissue incision, and operation in pulsed or continuous-wave modes. Previous laser-tissue interaction studies utilizing the thulium fiber laser have been limited to laser powers of less than 5W, restricting potential medical applications, suggested that the high-power thulium fiber laser has previously been shown to rapidly vaporize and coagulate soft urinary tissues. This article is to evaluate the short-term efficacy and safety of thulium laser resection of prostate (TmLRP) in the treatment of benign prostatic hyperplasia (BPH). Methods: A total of 52 patients who were diagnosed with BPH from September 2005 to December 2005 in our hospital were underwent TmLRP using a continuous-wave, high-power thulium fiber laser operating at 50 watt, a wavelength of 2.01 microm. Their average age is 69(50-86), with a mean prostate volume of (72.9±15.3)g (30-180g), average international prostate symptom score (IPSS) of (25.2±3.2), quality of life score(QOL)(5.3±0.3) and average maximum urinary flow (Q(max)) of (6.1±2.4)ml/s.All patients were taken with transrectal ultrasonography (TRUS), the digital rectal examination(DRE) and prostate-specific antigen (PSA) for excluding the prostate cancer. The indices such as Qmax, IPSS, QOS, and residual urine volumes were monitored and statistically analyzed, at preoperatively and at 3-6 months postoperatively. The short-term therapeutic effects were compared. Results: All patients were under Epidural anaesthesia, no one needed blood transfusion or developed TURS, and there were no deaths associated with surgery in this group. The operating time was (25-65) minutes, mean operating time was (35.5±15.4). No significant bleeding was found during operation. Post-operative bladder irrigation was no necessary in part of patients, most needed the mean bladder irrigating time 1 -2 d .The urethral catheter was indwelled for(3-5) days post-operatively, with 5 of 52 patients had LUTS after catheter remove. No patients had postoperative thrombophlebitis. Among the patients who were substantially bothered by urinary difficulties at base line had improvement. Prostate cancer was not found in the specimens removed after surgery. 3-6 month after the operation, the Q(max) was (19.8±2.2) ml/s and IPSS was (5.6±1.4), and QOL was (1.8±0.3), there were significantly improved compared with those preoperatively (P <0.05).By the end of 3-6 month follow-up no new cases of impotence and retrograde ejaculation had been found. None needed a second transurethral resection. By the end of follow-up no new cases of impotence and retrograde ejaculation had been found. No other significant difference in the symptoms of subjective and objective findings was noted compared with TURP. Conclusions: The high-power thulium fiber laser is capable of rapid vaporization and coagulation of the prostate. The TmLRP is believed to be a safe, efficacious and minimally invasive procedure for older patients with high-risk BPH. It is easier to manipulate with advantages of shorter operative time and a much shorter catheter time and hospital stay, less blood loss, better tolerance and rapid recovery. It appears to be an endourologic alternative to TURP for the treatment in BPH patients.